Video: Laparoscopic anterior cystogastrostomy

Robotic-assisted cystogastrostomy for a patient with a pancreatic pseudocyst

Pancreatic pseudocysts are generally treated by endoscopic cystogastrostomy. However, difficult cases involving abscess, necrosis, or risk of hemorrhage often require surgical intervention. Here, we report a case of a robotically assisted cystogastrostomy. The patient presented with an infected pseudocyst with adjacent varices. Use of the da Vinci Surgical System allowed us to create a widely patent anastomosis between the pseudocyst and the stomach. The patient tolerated the procedure well without any complications. This report demonstrates the feasibility of robotic cystogastrostomy.

Minimally invasive management of pancreatic pseudocysts

INTRODUCTION

The laparoscopic and endoscopic approaches to internal drainage of pancreatic pseudocysts (PP) are the current minimally invasive management options. Indications, and early and late results of endoscopic and laparoscopic approaches are being discussed.

AIM

To present experience in treatment of PP by laparoscopic pseudocystogastrostomy (LPGS) and endoscopic pseudocystogastrostomy (EPGS) and to compare results, feasibility and safety.

MATERIAL AND METHODS

THIRTY PATIENTS UNDERWENT SURGICAL INTERVENTION: 18 patients - LPGS (group I), 12 - EPGS (group II). Groups were compared by age, gender, pancreatic pseudocysts's age, diameter and localization, as well as intraoperative, early and late postoperative complications.

RESULTS

GENDER DISTRIBUTION, GROUP I: 14 (77.8%) men and 4 (22.2%) women, group II: 4 (33.3%) men and 8 (66.7%) women, p = 0.02. Average cyst diameter: group I - 149.9 ±52.1 mm, group II - 119 ±37.9 mm, p = 0.07. Average time between diagnosis and operation performance: group I - 12 (3-60) months, group II - 8 (2-36) months, p = 0.19. Neither in group I nor in group II did intraoperative complications occur. Early postoperative complications were divided into minor and major. Early minor complications: group I - 2 (11.1%), group II - 0, p = 0.5. Early major complications: group I - 0, group II - 2 (16.7%), p = 0.15. Late postoperative complications: group I - 0, group II - 1 (8.3%), p = 0.4. In group I there was no case, whereas in II group there was 1 (8.3%) case of recidivation, p = 0.4.

CONCLUSIONS

For selected patients both minimally invasive methods are equally safe an effective. For comprehensive evaluation of methods prospective trials are needed.

Laparoscopic cystogastrotomy by ultrasonic dissection after pylorus-preserving pancreaticoduodectomy

Laparoscopic cystenteric drainage of pancreatic pseudocysts remains feasible even after major open abdominal procedures.

Background and Objectives:

Symptomatic pancreatic pseudocysts can be drained using open, endoscopic, and laparoscopic techniques. Little is written on the role of laparoscopic drainage techniques after major abdominal operations. We describe a case of laparoscopic cystgastrotomy after pancreaticoduodenecomy.

Case Report:

A 55-year-old female with a prior history of open pylorus-preserving pancreaticoduodenectomy presented with multiple symptomatic pancreatic pseudocysts in the setting of alcohol-induced chronic pancreatitis.

Methods:

After preoperative planning with contrast-enhanced computed tomography, the patient successfully underwent laparoscopic cystgastrotomy with ultrasonic dissection.

Conclusion:

This case report illustrates that laparoscopic cystenteric drainage of pancreatic pseudocysts can be performed safely after major open abdominal operations. Further investigation is needed.